I've got this in a timeline for baby P based off opening speech and electronic evidence
23 June
6pm - Dr Gibbs reviewed P because O had died in unusual circumstances. The abdomen was full, mildly distended, no tenderness and active bowel sounds (good signs). He was screened for infection.
6pm - P was fed donor expressed milk signed only by LL
LL records, for the family communication: 'Parents kept updated on events throughout the afternoon - were present for some of the resuscitation and maternal grandmother present for support. '...Time alone [for parents and O] given. Photographs taken on mobile. Aware of need to keep lines/ET Tube in at present. 'O taken to family room to be with parents. Cooling cot arranged' (electronic evidence)
7.30/8pm – night-shift handover
8pm - P was fed donor expressed milk – there was a 14ml milk acidic aspirate. An x-ray taken at 8pm showed striking gaseous distension throughout the stomach and whole bowel.
8.24pm – LL made nursing notes for P.
On that night-shift milk feeds were stopped on the grounds that a further large part-digested aspirate was drawn up the NGT at feeding time.
8.35pm – LL made retrospective nursing notes for O for 1.15pm and 4.19pm (mix electronic evidence and opening speech)
8.51pm - A nursing note recorded at 20:51 by LL is being shown to court. It summarises O's deterioration and what happened with parents after (being taken to family room to be with him) (electronic evidence)
Shortly after 8.51pm –
Doc: Are you okay?
LL: 'think so, just finishing my notes, can't wait to get home. How are you?'
Doc: Had a moment in the car, bit better now.
doctor asks her if she is going to vote in the Brexit referendum
LL: 'no can't face that'
LL: Just walking home. Parents very grateful for everything. Nice to have some fresh air.
Doc: Your notes must have taken a long time. Had you documented anything from this morning?
LL: Can’t think straight, so took a while.
Doc: Phew, not the first day back you were expecting. I was glad you were there, everything felt safe. Thank you for looking out for me.
LL: No, but it happens. Don’t need to thank me, I’m pleased you were there, think we work well together. Sorry for my loss of composure moment
Doc: I was trying to say thanks for checking I was okay. We do work well together I’m glad you could talk to me and I hope I helped.
LL: That’s okay, good to talk it through otherwise carry it round.
Doc: There are very few things that a hug can’t help fix.
LL: One of those days
Doc: Thank you for keeping me company again. Sleep well.
LL: Don’t be daft, it’s a two-way thing and what friends are for. You had me blubbering, night.
Doc: Oh no, how guilty do I feel. Goodnight.
LL: Guilty? I mean you had to see me blubbering at work.
Doc: Oops my mistake. I thought it had tipped you over on the end of a bad day. Blubbering at work is normal for someone who cares about the families and babies that they look after.
LL: No, no I’m fully composed. Thank you a good cry is what’s needed sometimes. Hope you sleep.
Doc: Goodnight
Time? To a nursing colleague, LL: 'Lost a triplet today, been *advertiser censored* x'
colleague: *** hell, what happened?
LL: blew up abdomen, think it’s sepsis. Went very suddenly. IO access and abdominal drain
Colleague: how many weeks?
LL: 33
Colleague: assuming they all seemed stable if had all three?
LL: yeah, were all fine. This one still on Optiflow but weaning and all fully fed 2 x 12.
Colleague: Jesus
LL: had big tummy overnight but just ballooned after lunch and went from there.
Coll: big hugs. Be treating all of them with anti-b’s then, or think just that one?
LL: yeah, other two been re-screened and gases etc just in case, as not really sure what caused collapse. I want to be in Ibiza ☹
Coll: 'I bet you don't want to go back in tomorrow'
LL: 'I do and I don't' think good to go back in and talk about it'
Nurse: 'Poor parents'
LL said O had died on the student's first day of a four-week placement. She adds who was on duty that day.
Nurse: 'Lots of consultants then. bloody tragic news. We don't have any luck with 33-34wkrs. Never seem b able to tell do u
LL: 'Awful. No, not a good gestation. deteriorate so quick'.
nurse: hope other two have an easy ride now for the parents’ sake.
LL: worry as identical.
LL said one colleague was upset about what had happened.
LL adds: 'Yeah worried she's missed something'
Nurse: 'Wow identical triplets! Didn't know that even happened'
LL messaged a nursing colleague to suggest a cause of death as sepsis or NEC. She told police she thought that at the time because 'it was a discussion they had all had' on the unit."
LL’s mother messaged LL saying it was sad what had happened on the first day back after LL's holiday.
LL: 'Yep it's just as well I love my job!'
The doctor messages LL to say the debrief didn't find anything that was missed for the events of O.
LL messages the doctor to say 'apparently' she had sounded bossy around the time of the baptism call for O.
The doctor says he would interpret it as being proactive.
LL says she has 'broad shoulders' and had apologised, saying it could have been interpreted as being overly direct.
The two agree it had been a stressful situation.
24 Jun 2016, Fri – LL’s day-shift – murder charge child P
After midnight –
1.25am - The pair wish each other goodnight (electronic evidence)
6.39am – A nurse recorded P’s abdomen was soft and non-distended. 25ml of air had been aspirated by one of the nurses and the NGT had been placed on free-drainage. The problem P had when LL handed over to the night-shift had resolved. (opening speech)
Morning - doctor messages LL again that morning asking how she slept and letting her know that a medical director has been on ward (electronic evidence)
Ahead of the shift doctor messaged LL: "Are you OK? It's rubbish not to sleep well in the middle of 3 long days. Hope your day goes OK."
LL: "Hmm maybe. I'll be watching them both (Child P and the surviving triplet) like a hawk.
7.30/8am – LL’s day-shift. P’s designated nurse (and the third triplet) in room 2.
LL to doctor: "I'm OK. Just don't want to be here really. Hoping I may get the new admissions."
LL to doctor: “I might see if she (a student nurse) can work with someone else as don’t feel I’m in frame of mind to support her properly and paperwork to finish off”
8.30am - Text messages LL sent to a doctor at just after 8.30am suggest she had sent, or was sending, her student with a baby who needed an MRI scan.
Approx. 9.30am - LL's nursing notes from later that night (9.18pm-10pm) recorded: "Written in retrospect...NG tube on free drainage - trace amount in tube. Abdomen full – loops visible, soft to touch … Reg...arrived to carry out ward round – P had apnoea, brady, desat with mottled appearance requiring facial oxygen and neopuff for approx. 1 min. Abdomen becoming distended. Decision made to carry out bloods and gas (approx. 09:30)”
9.35am - A registrar noted P, at 9.35am, had “desat + bradys” and had a moderately distended / bloated abdomen and slightly mottled skin.
9.50am - P had an acute deterioration. A crash call went out. P was intubated and improved, and efforts were made to transfer him to Arrowe Park Hospital
11.30am - P desaturated again at 11.30am. He was given adrenaline.
His spontaneous circulation improved but he continued to deteriorate through the day.
11.57am - A punctured lung was identified from an x-ray taken at 11.57am, treatment started at 12.40pm.
12.40pm – treatment for punctured lung started.
3pm - The transport team arrived at 3pm. Just before they arrived, P's blood gases were taken and were satisfactory. A doctor was hopeful of P's prospects. The court hears LL said to her something like "he’s not leaving here alive is he?"
3.14pm - P's final collapse came at 3.14pm and, despite resuscitative efforts, he died at 4pm.